- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $380.19 / $2,754.23 / $3,890.45
| Facility | | $380.19 | $2,754.23 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $229.09 / $371.54 / $724.44
| Professional | | $229.09 | $371.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,884.03 / $13,489.63
| Facility | | $575.44 | $2,884.03 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $1,288.25
| Professional | | $269.15 | $478.63 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $288.40 / $660.69
| Facility | | $288.40 | $288.40 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $288.40 / $501.19 / $851.14
| Professional | | $288.40 | $501.19 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $257.04 / $478.63 / $977.24
| Professional | | $257.04 | $478.63 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $218.78 / $331.13 / $3,311.31
| Facility | | $218.78 | $331.13 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $426.58 / $524.81 / $741.31
| Professional | | $426.58 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,041.74 / $4,265.80 / $9,772.37
| Facility | | $2,041.74 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $489.78 / $977.24
| Professional | | $281.84 | $489.78 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $177.83 / $380.19 / $794.33
| Professional | | $177.83 | $380.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $575.44 / $2,884.03 / $13,489.63
| Facility | | $575.44 | $2,884.03 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $478.63 / $1,288.25
| Professional | | $269.15 | $478.63 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,862.09 / $3,890.45 / $8,709.64
| Facility | | $1,862.09 | $3,890.45 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $501.19 / $1,000.00
| Professional | | $281.84 | $501.19 | $1,000.00 |